Samantha S Domingues, COTA/L

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

2068 Issued in CA

Practice address

18350 Mount Langley St Ste 105
Fountain Valley, CA 92708-6923

Phone

(714) 965-2324

Fax

(714) 965-2684

NPI assigned

Jul 19, 2012

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Samantha Ann Sancho Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1342656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1342656000000",
    "number": "1811242373",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18350 MOUNT LANGLEY ST STE 105",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927086923",
            "telephone_number": "714-965-2324",
            "fax_number": "714-965-2684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18350 MOUNT LANGLEY ST STE 105",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927086923",
            "telephone_number": "714-965-2324",
            "fax_number": "714-965-2684"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMINGUES",
        "first_name": "SAMANTHA",
        "middle_name": "S",
        "credential": "COTA/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-19",
        "last_updated": "2012-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "CA",
            "license": "2068",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SAMANTHA",
            "last_name": "SANCHO",
            "middle_name": "ANN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Occupational Therapy Assistant in Fountain Valley, CA
• Providers in Fountain Valley, CA by specialty
• Occupational Therapy Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.